HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
90
ILL o h I�) P Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: (XA
� S ��
PROPOSED IMPROVEMENT LOCATION: Cn, ,�
Address: Y)� ,' �(`��K%SCjY�1 I VQ-,(_ ,+. GQ ��(A ' A�C 1 1 j`1 t 42
Property Tax ID#: 31'�X)- AC A- OCU ` �j Lot No.
Site Plan Name: Block No.
Project Name: 0L.
�� IONDESCRIPT OF WORK:
u CA fA0 ,
New Electrical Meter Second l Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical �Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ `-�,>�I� Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name A— y Name: t X
Address: n �tYI�S( 1 1 _ Company: i
c .
City ��`"�c r -p Stater Address: � _ - � `,\V
1�
Zip Code:? �-Aq�(P Fax: City: Stater
Phone No. 1,_kH•IH�- _Y �1 . Zip Code: n Fax:
E-Mail: Phone No n')?�(10 1
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License �j^j�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requesited permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are!exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. Ai Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an plAornewWore commencing work or recording our Notice of Commencement.
Signature of Ow er/Les e/Contractor as Agent for Owner
STATE OF FLOJUlYfL
COUNTY OF .LA
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this&° '`day of by
C;1
Name of person making statement.
Personally Known -,OR Produced Identification
e of Identification Produced L
(Signature of Notary Public-State of Florida}
.S�,pY PUp`,_�• DANIELLE GONCALVES
Commission No. (Seal :�s � ppyCOMMISSION#GG232946
N;
L"•XPIRES:June 27,2022
••Ei>F F��`P', 6�JnQed Thru Notary Public Undenedters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev
� s
m_. _ T� _
_
1
i
Pr(aposal / Agreement
Robert & Deborah Malek May 4, 2021
8726 Thompson Point Road
Port St Lucie, FL 34986
734-748-2246
rrmalek5520@aol.com
1) Supply and install (1) customer owned 500 gallon underground LP Tank with
gas line to generator and final connect.
2) Price includes 30ft extE nded service.
3) Price includes backfilling and removing dirt.
4) Obtain all permits & in!5pections needed.
5) Price does NOT include) filling the tank with propane, price per gallon will be
based off Thompson G s' market prices.
Charges&Payments: Charges are O:ue in full at time services are rendered unless otherwise stated below. Contractor may
charge and customer agrees to pay a late fee for all past due payments,such fees not to exceed the maximum allowed rate by
applicable law. Customer shall be re!�ponsible and agrees to pay for all charges billed, applicable taxes, applicable legal fees
and other charges/fees
Proposal/Con ract pricing good for 30 days from Proposal/Contract date
ad
00 due CO Gas Tank Install
..00 due Gas Une Connection
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
i _--
John Maruri 772-626-4691
Acceptance of Proposal
I, ?c (printed name), authorize Energized Gas to
complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date
Signature/
This agreement shall be construed under the la s of the State of Florida. This agreement contains the entire understanding of the
parties and supersedes all previous verbal or written agreements: there are no other agreements, representations or warranties not
set forth herein. If any conflicts exist in this agreement between terms which are printed and those which are typed or written, the
typed or written language shall govern.
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